Listeria monocytogenes endograft infection after fenestrated endovascular aneurysm repair-a case report.

An extremely uncommon cause of endograft infections, Listeria monocytogenes graft infections are associated with high morbidity and mortality. Best managed with complete graft resection and long-term antibiotic therapy, we present a rare case of L. monocytogenes aortic graft infection managed successfully with direct sac drainage and lifelong suppressive antibiotic therapy.

The identification and management of the profunda femoris artery as a rare source of a late type II endoleak.

Internal iliac artery aneurysms are found in 20% of abdominal aortic aneurysm cases, with a high mortality rate in the event of rupture. Type II endoleaks are a common complication after endovascular intervention. Transarterial or direct sac puncture techniques have superseded open surgical repair due to the challenging nature open surgery presents in accessing the feeding vessel(s). We describe the rare source of a late type II endoleak feeding from the profunda femoris in an 83-year-old man after fenestrated endovascular aortic aneurysm repair and concurrent embolization of the right internal iliac artery for treatment of a juxtarenal abdominal aortic aneurysm and internal iliac artery aneurysm.

Infrarenal aortic reconstruction using autologous femoral vein for a mycotic aneurysm caused by Streptococcus equi.

A common source of infection in equine, Streptococcus equi, is an uncommon pathogen in humans, rarely identified as the cause for mycotic aortic aneurysms. Typically associated with consumption of unpasteurized milk or contact with horses, S. equi can result in severe bacteremia, endocarditis and meningitis. We describe the presentation and successful management of a 69-year-old retired equestrian who underwent infrarenal aortic resection and reconstruction using autologous right femoral vein for a S. equi mycotic aneurysm.

Repair of a late endoleak following complete proximal endograft fixation strut separation.

Introduced as an alternative endograft for those with unfavorable anatomy, bare metal suprarenal fixation barbs have been widely used for endovascular abdominal aortic repair. Type I endoleaks result in continued perfusion of the aneurysm sac and warrant prompt reintervention. We describe an unusual presentation and endovascular management of a late type IA endoleak secondary to complete separation of the suprarenal fixation struts in a Cook endograft after an uncomplicated, emergent infrarenal endovascular abdominal aortic repair 5 years earlier.

The role of nutrition in wound healing: an overview.

Wounds are a commonly encountered and complex entity in healthcare, and often require multidisciplinary involvement for their management. Wound care and healing are affected by a range of factors of which nutrition, a modifiable factor, plays an integral part. Familiarity with the phases of wound healing and the differing nutritional requirements at each stage is fundamental to managing wounds. Additionally, awareness of the signs of malnutrition, screening tools and educational resources for managing malnutrition in primary care settings are all vital to minimising malnutrition and its adverse effects on wound healing. This article reviews the phases of wound healing and the associated nutritional requirements required for optimal healing, the clinical signs of malnutrition and screening resources for identifying at-risk groups, as well as reviewing current guidelines for managing malnutrition in the inpatient and outpatient setting.

Management of an inflammatory abdominal aortic aneurysm causing ureteric obstruction: a case report.

Inflammatory abdominal aortic aneurysms (IAAAs) are rare large-vessel pathology, with potentially life-threatening complications including obstructive uropathy secondary to retroperitoneal fibrosis. Comprising a small proportion of all AAA, their pathogenesis remains unknown, with the hypothesis of infective and immunological aetiologies circulating in current literature. Management principles of IAAAs aim at prevention of aortic rupture and include open-surgical or endovascular therapies. Due to their involvement of other structures, additional considerations are needed when approaching their management for optimal patient outcomes. We present the case of a 53-year-old otherwise healthy male with a large IAAA complicated by adjacent ureteric obstruction, successfully treated with ureteric stenting and delayed endovascular aortic aneurysm repair.

Upper limb phlegmasia cerulea dolens treated with single-session suction thrombectomy: a case report.

Phlegmasia cerulea dolens (PCD) of the lower limbs is a rare condition. PCD of the upper limbs is extremely uncommon, with only a select few cases documented in the literature. A complication of severe deep venous thrombosis, PCD, is characterized by the clinical triad of oedema, pain and limb cyanosis. Delays in treatment are associated with high rates of morbidity and mortality. We present a case of sudden-onset upper limb PCD in a 68-year-old man following haemodialysis through a long-term arteriovenous fistula. Prompt diagnosis and rapid initiation of intravenous anticoagulation followed by urgent single-session suction thrombectomy resulted in the successful restoration of vessel patency without any significant adverse sequelae on 3-month follow-up.

Acute bilateral renal vein thrombosis diagnosis and management: a case report.

Undifferentiated abdominal pain accounts for a significant proportion of emergency presentations and often presents as a diagnostic dilemma. Renal vein thrombosis (RVT) has many aetiologies including nephrotic syndrome, malignancy, trauma, infection and hypercoagulable states. RVT should be considered in cases of persistent abdominal pain where other, more common, pathologies have been excluded. We present the case of a 42-year-old male with a delayed diagnosis of bilateral RVT after presenting with multiple episodes of intractable abdominal pain and adverse sequelae of this condition. This case report aims to emphasize the importance of prompt RVT recognition and the utility of bedside emergency department (ED) investigations, which can guide initial differential diagnoses of abdominal pain, reduce the delay in diagnosis as well as limit unnecessary investigations.

The management of malignant lower limb ulcers: clinical considerations.

Lower limb malignant ulcers are an uncommon finding, making diagnosis complex and their management costly. Yet, despite this, the increase in skin cancers over the past 30 years means that clinicians require an awareness and understanding of their existence, particularly in the primary care setting. Familiarity with common aetiologies and presentations is vital for prompt recognition, diagnosis and referral of wounds suspicious for malignancy. Lower limb malignant wounds often develop insidiously, with a wide variation in clinical presentation that overlaps between entities. Therefore, a fundamental algorithm for approaching lower limb ulcers that raise suspicion of malignancy should be possessed by all clinicians. This article reviews the clinical features of malignant wounds that should alert clinicians to the need for further evaluation, such as atypical location and appearance. The authors also highlight the various diagnostic and therapeutic modalities available and review current clinical guidelines for the referral and follow-up of suspicious lesions.

Direct transarterial embolization via the deep circumflex iliac artery for a type II endoleak using a novel Onyx™ mixture.

Internal iliac artery aneurysms (IIAA) can be associated with abdominal aortic aneurysms. We describe a technique of successful transarterial embolization using a mixture of Onyx™ formulations in a 72-year-old with previous open and endovascular aneurysm repairs of his abdominal aorta and a residual large left IIAA causing a Type II endoleak. We demonstrate that utilization of the deep circumflex iliac artery is a safe and viable alternate route to treating IIAA when direct access is not achievable.