Repeated Pseudoaneurysm after Endovascular Repair of Popliteal Aneurysm due to Graft Disintegration and Fabric Tear.

Endovascular repair of popliteal artery aneurysms (PAA) using a stent graft is suitable for patients with favorable anatomy. In the domestic situation where Gore Medical withdrew, we report two cases of unusual complications of pseudoaneurysm after endovascular repair of PAA. A 44-year-old male with a history of bypass surgery for a PAA presented with recurrent vein graft pseudoaneurysm. Endovascular treatment using a domestic stent graft was performed. However, pseudoaneurysm developed due to the graft fabric tear 1 month later, requiring surgical removal. In another case, an 84-year-old female presented with acute limb ischemia related to PAA. Endovascular aneurysm repair with the same domestic stent graft was performed. However, stent graft failure occurred 2 years later and the patient underwent open surgical repair. There was a graft fabric disintegration. When proper endovascular device is not available, open surgical treatment is the best option for treating PAA.

Clinical outcomes of transposed brachial-basilic vein fistula: Tunneling versus elevation.

BACKGROUND: The Kidney Disease Outcome Quality Initiative (KDOQI) suggests a transposed brachial basilic vein fistula (TBBVF) in the patients who have good likelihood of long-term survival. To superficialize the basilic vein, a disconnected basilic vein is anterolaterally transposed inside a subcutaneous tunnel. A simple elevation in situ is an alternative technique. The aim of this study was to compare clinical outcomes of TBBVF according to the type of superficialization. METHODS: A total of 42 patients (mean age of 66 years, male: 45%) who underwent a TBBVF from April 2014 to March 2019 at our hospital were retrospectively reviewed. The method of superficialization (tunneling (n = 18) vs elevation (n = 24)) was determined by the surgeon's preference. It was done as a one-stage surgery. There was not any statistically significant difference in demographic or clinical characteristics of patients between the two groups. As early outcomes, postoperative mortality and morbidity were investigated. For clinical outcomes, primary patency, primary-assisted patency, and secondary patency were analyzed for both groups. RESULTS: There was a case of a 30-day mortality in the elevation group. Regarding morbidities, there was a postoperative bleeding in the tunneling group and a steal syndrome in the elevation group. The mean follow-up was 28 months (range, 0-63 months). There was no significant difference in primary patency (64.8% vs 77.5% in 1 year and 54.0% vs 54.1% at 3 year; p = 0.816), primary-assisted patency (88.9% vs 86.5% in 1 year and 88.9 vs 81.4 at 3 year; p = 0.624), or secondary patency (100% vs 86.5% in 1 year and 100% vs 86.5% at 3 year; p = 0.126) between the two groups. CONCLUSIONS: Clinical outcomes of TBBVF showed no significant difference between tunneling and elevation groups. Thus, TBBVF can be done with either method.

Intraoperative microembolic signals during carotid endarterectomy.

OBJECTIVES: Transcranial Doppler ultrasonography (TCD) can detect microembolic signals (MESs) that are one of the pathogenic indications of ischemic stroke. However, MESs are not uncommon findings during carotid endarterectomy (CEA). The aim of this study was to evaluate the association between MESs and postoperative neurologic events (transient ischemic attack [TIA] or stroke) or new brain lesions (NBLs) on magnetic resonance imaging (MRI). METHODS: Of the 205 patients who underwent CEA, 160 who were monitored intraoperatively for MES using TCD were enrolled and reviewed retrospectively. MESs were counted until carotid cross-clamping. Postoperative neurologic examination and MRI was performed between postoperative day 1 and 7 in 131 patients. The binary logistic regression model was used to identify independent predictors of postoperative neurologic events or NBLs. RESULTS: MESs during dissection or carotid clamping was observed in 50 patients (31%) and 20 patients (13%) showed MESs > 10. The postoperative ischemic stroke rate was 3% (4/160), and MRI revealed NBLs in 19% (25/131). On univariate analysis, the presence of MESs or MESs > 10 was not related to postoperative neurologic events or NBLs. On binary logistic regression analysis, MESs > 10 was not an independent predictor of NBLs (P = 0.873, OR: 1.129, CI: 0.256 - 4.972). CONCLUSIONS: MESs were frequently found during CEA. However, they were not associated with NBLs.

Endovascular Repair of an Ilio-Iliac Arteriovenous Fistula with Pseudoaneurysm after Lumbar Disc Surgery: A Case Report.

Aortoiliac vascular injury during lumbar disc surgery is potentially life-threatening, but occasionally presents with delayed-onset symptoms. This is a case report of a fistulized pseudoaneurysm presenting with claudication. A 73-year-old female presented with swelling of the left leg and short-distance claudication. Two months prior, she had undergone discectomy for the management of right foot drop caused by an L4-L5 herniated lumbar disc. The left ankle-brachial index was 0.71. Computed tomography angiography revealed a 31 mm×20 mm pseudoaneurysm of the left common iliac artery fistulized to the left common iliac vein. The patient was successfully treated with stent graft placement.