Endovascular repair of an abdominal aortic aneurysm in a patient with stenosis of bilateral common iliac artery stents.

BACKGROUND: The explosion in endovascular interventions for peripheral vascular disease has resulted in procedures being used by a multitude of specialties. Nonvascular surgeons performing these interventions can create scenarios that may make future vascular interventions difficult. In this article, we present a case report illustrating this point. METHODS: A 68-year-old man with severe chronic obstructive pulmonary disease, coronary artery disease with prior myocardial infarction, and multiple abdominal operations presented with an abdominal aortic aneurysm. In our opinion, this patient was at a prohibitive operative risk for open repair. Review of his imaging results revealed a 6.7-cm infrarenal aneurysm with bilateral common iliac artery (CIA) stents (right: 8 mm; left: 6 mm) and 6-mm self-expanding stents extending from the right external iliac artery through the common femoral artery. A Cook Zenith Renu (30 × 108 mm) graft (Cook Medical Inc., Bloomington, IN) was advanced after serial dilation and balloon angioplasty of the stenotic right CIA stent. Left brachial access was used for arteriographic imaging. The left common femoral artery was accessed and the left CIA was coil-embolized to prevent backbleeding. A femoro-femoral artery crossover bypass was then performed after segmental resection of the right common femoral artery stent. RESULTS: The patient tolerated the procedure well and was discharged home on postoperative day 3. Subsequent postoperative computed tomography arteriogram after 1 month showed palpable pulses and no evidence of endoleak with flow in the femoro-femoral graft on clinical exam. CONCLUSIONS: This case demonstrates an endovascular intervention which limited the potential options available for aneurysm repair. Similar problems may become increasingly common as more providers offer endovascular interventions, thus emphasizing the importance of a collaborative approach to the patient with complex aorto-iliac occlusive disease and abdominal aortic aneurysm. It is the duty of the vascular surgeon to offer his vital expertise and leadership in the care of these patients.

Use of recombinant factor VILa in Operation Iraqi Freedom and Operation Enduring Freedom: survey of Army surgeons.

Military physicians are using recombinant factor VIIa (rFVIIa) in Iraq and Afghanistan to help stop life-threatening hemorrhage in trauma patients. We constructed a questionnaire and surveyed Army general surgeons deployed to Iraq and/or Afghanistan about their predeployment experience, deployment experience, and projected postdeployment practice regarding rFVIIa usage. Most surgeons had rFVIIa available during their deployment (65%). The drug was used with varying frequency and subjective therapeutic effect. A majority of surgeons (79%) were unaware of any guideline or policy governing the use of rFVIIa. Seventy percent of respondents would use the drug in their future practice. Deployed surgeons generally have positive attitudes regarding the use of rFVIIa, but greater guidance and outcome measures are needed.