A carotid bifurcation pseudoaneurysm treated endovascularly in a patient with irradiated neck.

A carotid artery pseudoaneurysm in an irradiated neck is a rare entity with possible devastating results and management should be multidisciplinary. We present a successful endovascular treatment of a late carotid artery pseudoaneurysm following patch endarterectomy and cervical radiotherapy.

Primary aortoenteric fistula due to septic aortitis.

Primary aortoenteric fistula is most commonly caused from erosion of the bowel wall by an abdominal aortic aneurysm. Septic aortitis with pseudoaneurysm formation and finally erosion into the duodenum represents a rare cause that has been described in very few patients in the literature. We present a rare clinical case of Salmonella aortitis and associated infrarenal aortic pseudoaneurysm that evolved into an aortoduodenal fistula. A 51-year-old man was admitted in our hospital with symptoms and signs of sepsis caused by Salmonella bacteremia. Imaging studies revealed an infrarenal aortic pseudoaneurysm. The patient presented hemodynamic instability, and during emergency laparotomy a fistula was found between the third portion of the duodenum and a false aneurysm arising from a nonaneurysmal grossly infected aorta. The affected aortic segment was excised and the intestinal defect was repaired. The aortic stumps were sutured and an axillobifemoral bypass was performed. The patient had an uncomplicated postoperative course.

Endovascular treatment of a primary aortoduodenal fistula: 2-year follow-up of a case report.

The purpose is to evaluate the role of endovascular management for primary aortoduodenal fistula in poor surgical risk patients. A 70-year-old-man was admitted at the emergency room of our hospital with recurrent upper-gastrointestinal bleeding. A diagnostic workup was suggestive of a primary aortoduodenal fistula caused by erosion of an infrarenal abdominal aortic aneurysm. Intractable cardiac arrhythmia, recurrent hemorrhage, and poor patient condition were compatible with an exceedingly high surgical risk. The fistula was successfully treated, and gastrointestinal bleeding was eliminated with placement of a Lifepath endoluminal aortoiliac stent graft. At the 21-month follow-up, the patient was not presenting with symptoms and signs of graft infection, and radiologic studies confirmed decreasing aneurysm size without associated signs of local sepsis. Endovascular stent grafts can efficiently arrest massive exsanguination in critically ill patients with primary aortoenteric fistula. The risk of graft infection remains the most serious problem associated with this approach.

Arterial compromise caused by lower limb osteochondroma.

Osteochondromas occasionally cause arterial complications, mainly concerning the distal superficial femoral and popliteal arteries. The authors present 11 patients (12 cases) with arterial disorders caused by exostoses who were hospitalized in their Vascular Clinic. All but 1 had signs or symptoms of peripheral arterial disease such as intermittent claudication or diminished peripheral pulses, and 1 also presented serious neurologic sequelae. All were examined by radiography, ankle-brachial index (ABI), computed tomography scan, color duplex scan, arteriography, and scintigraphy. The popliteal artery was the most commonly affected vessel in 7 cases. In addition to the removal of the offending osteochondroma, 7 patients underwent excision of the diseased arterial segment and replacement by a saphenous vein interposition graft. The remaining 5 cases received a vein graft patch. The authors achieved good results with no serious complications detected in the immediate postoperative period and subsequent follow up. Surgical treatment of the vascular complications caused by exostoses is mandatory. Even in the absence of vascular symptoms, such bony lesions in close proximity to a vessel should be on a close follow-up in order to prevent permanent arterial damage.