Percutaneous Endovascular Aortic Aneurysm Repair with INCRAFT Endograft Guided by CO2 Digital Subtraction Angiography in Patients with Renal Insufficiency

Iodinated contrast is the most common contrast agent used during endovascular abdominal aneurysm repair (EVAR). However, its use may worsen kidney function in patients with renal insufficiency. Previous studies have demonstrated the safety and effectiveness of carbon dioxide (CO2)-EVAR. Here, we report cases of three male patients with mild renal insufficiency (mean age: 79 years) that successfully underwent CO2-EVAR using INCRAFT ultra-low profile endografts. CO2 angiography provided the necessary vascular roadmap for safe and effective percutaneous EVAR, eliminating the need for iodinated contrast media and preventing contrastinduced nephropathy.

Sequential Hybrid Repair of Aorta and Bilateral Common Iliac Arteries Secondary to Chronic Aortic Dissection with Extensive Aneurysmal Degeneration in a Marfan Patient

Marfan syndrome is a connective tissue disorder associated with aortic dissection, aneurysmal degeneration and rupture. These cardiovascular complications represent the main cause of mortality, therefore repair is indicated. We present a 35-year-old woman who experienced acute onset of chest pain. Her imaging revealed a chronic DeBakey type I dissection with aortic root dilation and descending thoracic aneurysmal degeneration. She underwent a Bentall procedure and endovascular exclusion of the descending thoracic aortic aneurysm. She was closely followed and 2 years later a computed tomography angiography (CTA) revealed the aneurysmal degeneration of the thoracoabominal aorta and bilateral iliac arteries. The patient underwent a composite reconstruction using multi-visceral branched and bifurcated Dacron grafts. At 5 years from her last surgery, a CTA revealed no new dissection or further aneurysmal degenerations. Aortic disease in Marfan patients is a complex clinical problem that may lead to secondary or tertiary aortic reconstructions; close follow-up is mandatory.

Aortobifemoral Reconstruction with Right Extra-Anatomic Obturator Foramen Bypass due to a Septic Groin

The aortic bifurcation and iliac vessels are common sites of atherosclerotic occlusive disease causing the clinical expression known as "Leriche's syndrome". An aortobifemoral bypass grafting in the setting of a septic groin remains a significant challenge to vascular surgeons. We present a 65-year-old male with complete occlusion of the distal aorta and iliac arteries; he had undergone a left axillo-femoral and femoral-femoral artery bypass 2 years prior to our evaluation. Owing to a complex graft infection in the right groin and worsening lower extremity ischemia, we performed an aortobifemoral reconstruction through the right obturator membrane. This report highlights the safety and efficacy of the obturator bypass for avoiding infected groins while preserving vascular continuity and durability with 78 months of secondary patency rate.