Colapso proximal de una endoprótesis de aorta abdominal: reparación endovascular / Proximal abdominal aortic endograft collapse: endovascular repair

Introducción: el colapso de una endoprótesis en la aorta abdominal constituye una complicación muy poco frecuente, normalmente debida a una mala aposición de la prótesis sobre la pared arterial. La reparación endovascular suele ser la modalidad más utilizada para realinear el dispositivo, aunque no existe una actuación protocolizada. Caso clínico: presentamos el caso de un varón de 67 años diagnosticado de colapso precoz asintomático de una endoprótesis de aorta abdominal con una endofuga de tipo Ia. La tomografía computarizada reveló una invaginación severa del segmento proximal de la endoprótesis, así como un marcado crecimiento del saco aneurismático en el primer mes. Se implantó un stent balón expandible para realinearla de nuevo y reforzar el cuello, con excelente resultado. Discusión: las técnicas endovasculares, como la implantación de un stent, parecen una opción segura para volver a alinear el extremo proximal de una endoprótesis tras su colapso.(AU)

Introduction: in the abdominal aorta, device infolding or collapse is an extremely rare complication, usually related to a poor apposition of the proximal end of the device at the time of intervention. Endovascular repair is the most widely used modality to realign the device. However, there is no consensus on the management. Case report: we present a case of a 67-year-old man with early endograft infolding of the abdominal aorta associated with type Ia endoleak. The patient was asymptomatic, without ischemic limb complications. Computed tomography angiography reveled severe invagination of the proximal end of the stent graft, and marked growth of the aneurysm sac during the first month of follow-up. We decided to start by expanding the proximal sealing stent with balloon angioplasty. Finally, we used a balloon-expandable stent to realign and reinforce the proximal end of the endograft. This endovascular technique may be an effective endovascular adjunct to treat abdominal endograft collapses. Discussion: endovascular repair, as stent implantation, may be a secure option to realign the proximal end of the endoprosthesis after its collapse.(AU)

Iliac Arteries Dissection with a Rapid Dilatation as Debut of Fibromuscular Dysplasia.

We report a case of a 38-year-old male diagnosed with fibromuscular dysplasia (FMD) and a dissection of both common iliac arteries without aortic involvement. It was revealed after an inguinal hematoma and a pelvic pain, which are not the typical FMD presentation. Surgical treatment was performed after a rapid iliac growth in the first month control computed tomography angiography. Although the clinical course of this entity is relatively benign, rupture of the common iliac artery has also been described.

Endovascular treatment of external iliac artery occlusive disease: midterm results.

PURPOSE: To report midterm outcomes for endovascular treatment of external iliac artery (EIA) occlusive disease and assess possible factors affecting patency. METHODS: A retrospective analysis was conducted of 99 consecutive patients (91 men; mean age 67.3 years) with claudication (n=70) or critical limb ischemia (n=29) owing to occlusive EIA disease treated at our center from January 2005 to June 2012. The majority of lesions (79/108) were TASC A/B. Lesions were a mean 42.2 mm long (range 10-125); 43/108 affected the distal third of the EIA. Balloon angioplasty alone was performed in 7 limbs, while the remaining 101 lesions were stented (65 self-expanding, 24 balloon-expandable, and 12 covered). Clinical and hemodynamic follow-up was performed at 1, 3, 6, and 12 months after therapy and yearly thereafter. The factors examined were procedure characteristics and patency rates. RESULTS: Over a median follow-up of 27.5 months (range 1-89), there were 2 (1.9%) early occlusions followed by a successful reintervention, 4 late occlusions, and 5 hemodynamic failures followed by 7 reinterventions. These events led to primary and secondary patency rates at 30 months of 89.7% and 94.1%, respectively. No differences in patency rates were detected according to age, clinical state, or comorbidity. Use of covered stents (p=0.006) was the only variable associated with lower primary patency rates. CONCLUSION: Endovascular therapy to treat TASC A/B lesions of the EIA yielded good short and midterm patency and low early morbidity and mortality. Lesions involving the distal third of the EIA treated by simple angioplasty ± stenting fared worse. No clinical factors could be correlated with patency.

Cystic adventitial degeneration of the popliteal artery: report on 3 cases and review of the literature.

BACKGROUND: Cystic adventitial disease (CAD) is a rare, nonatherosclerotic vascular condition predominantly seen in middle-aged men with no cardiovascular risk factors. Three cases have been diagnosed and treated in our institution during the past 8 years. The purpose of this report is to provide an updated literature review of this condition with the addition of 3 new cases. METHODS: Information about 3 new cases is presented along with data obtained from articles published between 1979 and 2012 from PubMed and Embase databases. Two hundred thirty-eight articles were found, and 98 were included in our review. RESULTS: All patients treated presented with rapidly progressive intermittent calf claudication. Diagnosis of CAD was confirmed by at least 2 imaging techniques, either duplex ultrasound or magnetic resonance imaging, with a preoperative angiography performed in all cases. Wall cyst resection was performed in the 3 cases reported here, after intraoperative confirmation that there was no arterial wall damage. All patients remained asymptomatic with no signs of recurrence after a median 36-month follow-up (24-60 month follow-up). CONCLUSIONS: CAD is a rare vascular condition usually affecting arteries that presents as a sudden onset of unilateral intermittent calf claudication. Diagnosis must be confirmed with imaging techniques, such as duplex ultrasonography and magnetic resonance imaging. On the basis of existing knowledge, surgery remains the treatment of choice, with cystic evacuation in cases with no arterial wall damage or resection and grafting. However, the follow-up algorithm for treated patients remains unclear.